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Cureus Apr 2024Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed...
Impact of Pronator Quadratus Muscle Tear in Distal Radius Fractures on Patient Outcomes: Analyses of 55 Patients in a Volar Locking Plate Arm of a Randomized Clinical Trial.
Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed in the literature. The aim of this study was to compare grip strength, patient-reported outcomes, and functional results between patients with an intact PQ and those with a ruptured PQ before undergoing surgery with a volar locking plate for dorsally displaced unstable extra-articular DRFs. Methods A total of 120 patients aged 55 years and older were included in a randomized controlled trial comparing a volar locking plate with a dorsal nail plate. Of the 60 patients randomized to the volar plate group, the integrity of the PQ muscle was recorded during surgery for 55 patients, who were included in this study. The outcomes measured were the Quick Disabilities of the Arm, Shoulder, and Hand Outcome Measure (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE) score, the EQ-5D index, the visual analog scale (VAS) score, grip strength, and range of motion (ROM). Results The median age was 67 years (range 55 to 88), and the one-year follow-up rate was 98%. Patients with an identified intact PQ (28/55) before surgical release had better QuickDASH scores after one year (2.5 vs 8.0, mean difference 5.5, 95% CI: 1.3 to 9.8, p=0.028). Patients in the intact group also had better EQ-5D Index scores after one year (0.94 vs 0.85, mean difference 0.089, 95% CI: 0.004 to 0.174, p=0.031), and demonstrated better grip strength throughout the trial; after one year: 24 kg vs 20 kg (mean difference 3.9; 95% CI: 0.3 to 7.6, p=0.016). After one year, the intact group had regained 96% of their grip strength and the nonintact group had regained 93% of their grip strength compared to the uninjured side. The observed differences may be of questionable clinical importance, as they were lower than those of previously proposed minimal clinically important differences (MCIDs). Conclusions Patients with a DRF and a ruptured PQ prior to surgery exhibited higher QuickDASH scores and lower EQ-5D index scores after one year. The integrity of the PQ should be reported in future studies.
PubMed: 38765412
DOI: 10.7759/cureus.58576 -
Cureus Apr 2024A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are...
A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are indicative of ligamentous injury in the knee. In this case report, a 29-year-old male delivery driver presented to the ED with acute onset right knee pain after losing control of his motorbike at low speed. Examination revealed significant effusion and medial and lateral joint line tenderness. An anterior-posterior radiograph of the knee showed a Segond fracture. Subsequent MRI confirmed a full-thickness anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) tear. Despite surgical reconstruction options, the patient chose conservative management. At eight-week follow-up, he demonstrated satisfactory progress. This case highlights the diagnostic significance of Segond fractures in identifying ligamentous damage in the knee without the availability of MRI. It also highlights the feasibility of non-operative management in some instances.
PubMed: 38765369
DOI: 10.7759/cureus.58588 -
Orthopedic Reviews 2024One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the...
BACKGROUND
One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the double-plate osteosynthesis for these fractures.
METHODS
An acromion type III fracture according to classification of Levy was simulated in 16 human shoulder cadavers, and the specimens were randomly divided into two groups. Single-plate osteosynthesis was performed in the first group (locking compression plate) and double-plate osteosynthesis (locking compression plate and one-third tubular locking plate) in the second group. Biomechanical testing included cycling load and load at failure on a material testing machine. During the test, the translation was measured using an optical tracking system.
RESULTS
The load at failure for the single-plate osteosynthesis was 167 N and for the double-osteosynthesis 233.7 N ( = 0.328). The average translation was 11.1 mm for the single-plate osteosynthesis and 16.4 mm for the double-plate osteosynthesis ( = 0.753). The resulting stiffness resulted in 74.7 N/mm for the single-plate osteosynthesis and 327.9 N/mm for the double-plate osteosynthesis ( = 0.141).
DISCUSSION
Results of the biomechanical study showed that double-plate osteosynthesis had biomechanical properties similar to those of single-plate osteosynthesis for an acromion type III fracture at time point zero. The missing advantages of double-plate osteosynthesis can be explained by the choice of plate configuration.
PubMed: 38765296
DOI: 10.52965/001c.88396 -
Frontiers in Endocrinology 2024There is a controversy in studies of circulating inflammatory proteins (CIPs) in association with osteoporosis (OP) and fractures, and it is unclear if these two...
OBJECTIVE
There is a controversy in studies of circulating inflammatory proteins (CIPs) in association with osteoporosis (OP) and fractures, and it is unclear if these two conditions are causally related. This study used MR analyses to investigate the causal associations between 91 CIPs and OP and 9 types of fractures.
METHODS
Genetic variants data for CIPs, OP, and fractures were obtained from the publicly available genome-wide association studies (GWAS) database. We used inverse variance weighted (IVW) as the primary analysis, pleiotropy, and heterogeneity tests to analyze the validity and robustness of causality and reverse MR analysis to test for reverse causality.
RESULTS
The IVW results with Bonferroni correction indicated that CXCL11 (OR = 1.2049; 95% CI: 1.0308-1.4083; = 0.0192) can increase the risk of OP; IL-4 (OR = 1.2877; 95% CI: 1.1003-1.5070; = 0.0016), IL-7 (OR = 1.2572; 95% CI: 1.0401-1.5196; = 0.0180), IL-15RA (OR = 1.1346; 95% CI: 1.0163-1.2668; = 0.0246), IL-17C (OR = 1.1353; 95% CI: 1.0272-1.2547; = 0.0129), CXCL10 (OR = 1.2479; 95% CI: 1.0832-1.4377; = 0.0022), eotaxin/CCL11 (OR = 1.1552; 95% CI: 1.0525-1.2678; = 0.0024), and FGF23 (OR = 1.9437; 95% CI: 1.1875-3.1816; = 0.0082) can increase the risk of fractures; whereas IL-10RB (OR = 0.9006; 95% CI: 0.8335-0.9730; = 0.0080), CCL4 (OR = 0.9101; 95% CI: 0.8385-0.9878; = 0.0242), MCP-3/CCL7 (OR = 0.8579; 95% CI: 0.7506-0.9806; = 0.0246), IFN-γ [shoulder and upper arm (OR = 0.7832; 95% CI: 0.6605-0.9287; = 0.0049); rib(s), sternum and thoracic spine (OR = 0.7228; 95% CI: 0.5681-0.9197; = 0.0083)], β-NGF (OR = 0.8384; 95% CI: 0.7473-0.9407; = 0.0027), and SIRT2 (OR = 0.5167; 95% CI: 0.3296-0.8100; = 0.0040) can decrease fractures risk.
CONCLUSION
Mendelian randomization (MR) analyses indicated the causal associations between multiple genetically predicted CIPs and the risk of OP and fractures.
Topics: Humans; Mendelian Randomization Analysis; Osteoporosis; Genome-Wide Association Study; Fractures, Bone; Polymorphism, Single Nucleotide; Fibroblast Growth Factor-23; Genetic Predisposition to Disease; Female; Osteoporotic Fractures
PubMed: 38757000
DOI: 10.3389/fendo.2024.1386556 -
Journal of ISAKOS : Joint Disorders &... May 2024The incidence of complex articular fractures of the distal humeral in adults has increased and will be growing in the future due to the greater incidence of high-energy...
The incidence of complex articular fractures of the distal humeral in adults has increased and will be growing in the future due to the greater incidence of high-energy trauma and to the higher percentage of the elderly population. Successful treatment is challenging for the needed balance between the stability of often comminuted fractures and early motion. Malunion is a common complication after distal humerus fractures that is influenced by a variety of factors, such as biology, particularly the blood supply of the metaphysis, the nonanatomical reduction of the fracture, the methods of fixation, and mechanical failure. These can involve the intra-articular or extra-articular areas. The clinical presentation may be mainly with pain and instability as for the cubitus varus, or with disfunction and stiffness as for an intra-articular malunion. However, the symptoms will depend on the degree of articular surfaces damage and the degree of deformities in specific planes. The surgical treatment can be challenging, varying from supracondylar osteotomies and re-contouring arthroplasty for extra-articular deformities to interposition arthroplasty, and elbow replacement for intra-articular deformities.
PubMed: 38754837
DOI: 10.1016/j.jisako.2024.05.009 -
Journal of Orthopaedic Surgery (Hong... 2024Different techniques have been described for glenoid fractures, there is still a need for safe and effective agents to promote outcomes. From January 2016 to April 2021,...
Different techniques have been described for glenoid fractures, there is still a need for safe and effective agents to promote outcomes. From January 2016 to April 2021, the clinical data of 17 patients with pulley type IA fractures treated by the V-shaped fixation technique under shoulder arthroscopy were retrospectively analyzed. Preoperative X-ray, CT, and MRI examinations were completed. The functional score of the shoulder joint, such as the visual analog scale (VAS), Constant score, and Modified Rowe score, was used to evaluate the preoperative and final follow-up clinical outcomes. The active shoulder range of motion (ROM) was also collected preoperatively and at the final postoperative follow-up. Accordingly, intraoperative and postoperative complications were also observed. The mean follow-up was 49.52 months (16-79 months). The patients' follow-up exams showed that shoulder joint flexion, abduction, external rotation, internal rotation, and pain were not significantly different from those of the contralateral side ( > .05). The mean Constant score was 83.52 (58-98), and the average Modified Rowe score was 94.29 (70-100). X-ray and CT films of all cases showed good healing without articular depression or steps. Three patients had traumatic arthritis, with VAS <3 pain. No postoperative complications, such as infections, nerve or vessel damage, or suture anchor problems occurred during the follow-up period. Using the Double-pull, V-shaped fixation technique can stabilize the reduction of glenoid fractures while reducing the possibility of bone destruction. It is a good solution and provides an opportunity to treat rotator cuff tears associated with the procedure.
Topics: Humans; Male; Arthroscopy; Female; Retrospective Studies; Middle Aged; Adult; Fracture Fixation, Internal; Range of Motion, Articular; Glenoid Cavity; Fractures, Bone
PubMed: 38749489
DOI: 10.1177/10225536241254913 -
Journal of the American Academy of... May 2024Instrumented spinal fusions can be used in the treatment of vertebral fractures, spinal instability, and scoliosis or kyphosis. Construct-level selection has notable...
BACKGROUND
Instrumented spinal fusions can be used in the treatment of vertebral fractures, spinal instability, and scoliosis or kyphosis. Construct-level selection has notable implications on postoperative recovery, alignment, and mobility. This study sought to project future trends in the implementation rates and associated costs of single-level versus multilevel instrumentation procedures in US Medicare patients aged older than 65 years in the United States.
METHODS
Data were acquired from the Centers for Medicare & Medicaid Services from January 1, 2000, to December 31, 2019. Procedure costs and counts were abstracted using Current Procedural Terminology codes to identify spinal level involvement. The Prophet machine learning algorithm was used, using a Bayesian Inference framework, to generate point forecasts for 2020 to 2050 and 95% forecast intervals (FIs). Sensitivity analyses were done by comparing projections from linear, log-linear, Poisson and negative-binomial, and autoregressive integrated moving average models. Costs were adjusted for inflation using the 2019 US Bureau of Labor Statistics' Consumer Price Index.
RESULTS
Between 2000 and 2019, the annual spinal instrumentation volume increased by 776% (from 7,342 to 64,350 cases) for single level, by 329% (from 20,319 to 87,253 cases) for two-four levels, by 1049% (from 1,218 to 14,000 cases) for five-seven levels, and by 739% (from 193 to 1,620 cases) for eight-twelve levels (P < 0.0001). The inflation-adjusted reimbursement for single-level instrumentation procedures decreased 45.6% from $1,148.15 to $788.62 between 2000 and 2019, which is markedly lower than for other prevalent orthopaedic procedures: total shoulder arthroplasty (-23.1%), total hip arthroplasty (-39.2%), and total knee arthroplasty (-42.4%). By 2050, the number of single-level spinal instrumentation procedures performed yearly is projected to be 124,061 (95% FI, 87,027 to 142,907), with associated costs of $93,900,672 (95% FI, $80,281,788 to $108,220,932).
CONCLUSIONS
The number of single-level instrumentation procedures is projected to double by 2050, while the number of two-four level procedures will double by 2040. These projections offer a measurable basis for resource allocation and procedural distribution.
Topics: Humans; United States; Medicare; Spinal Fusion; Aged; Forecasting; Female; Health Care Costs; Male; Aged, 80 and over
PubMed: 38743853
DOI: 10.5435/JAAOSGlobal-D-24-00053 -
Anesthesiology and Pain Medicine Feb 2024Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed...
BACKGROUND
Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging.
OBJECTIVES
This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation.
METHODS
This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: One receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student's -tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05.
RESULTS
A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's -test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA.
CONCLUSIONS
The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.
PubMed: 38737591
DOI: 10.5812/aapm-142051 -
Saudi Medical Journal May 2024To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy.
OBJECTIVES
To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy.
METHODS
Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb).
RESULTS
A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, <0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, <0.001).
CONCLUSION
This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.
Topics: Humans; Musculoskeletal Diseases; Prevalence; Male; Female; Saudi Arabia; Adult; Middle Aged; Retrospective Studies; Upper Extremity; Lower Extremity; Aged; Young Adult; Adolescent
PubMed: 38734426
DOI: 10.15537/smj.2024.45.5.20230941 -
Diagnostics (Basel, Switzerland) Apr 2024Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and... (Review)
Review
Glenoid fossa fractures are rare injuries accounting for 10 to 29% of all intra-articular scapula fractures. They are usually the result of high-energy trauma, and concomitant injuries are not uncommon. Patients with glenoid fractures are admitted with shoulder pain and restricted range of motion. Although shoulder plain radiographs could establish the diagnosis, a computed tomography scan is necessary to adequately define the fracture pattern and characteristics. The most commonly used classification system is that of Ideberg (modified by Goss), which includes five glenoid fossa fracture types according to the location, extension, and complexity of the lesion. Articular surface displacement and step-off are the most important factors that should be taken under consideration when deciding for conservative or surgical management. Operative treatment includes open reduction and internal fixation through a posterior or anterior approach depending on fracture morphology and displacement. However, open surgical techniques are related to extensive soft-tissue disruption, risk of neurovascular injury, and inadequate exposure of the entire glenoid cavity. Introduction of arthroscopy could facilitate better visualization of the glenoid articular surface and improved fracture reduction. However, it is a technically demanding procedure with many challenges and pitfalls. The aim of this review is to summarize the current evidence regarding the treatment of glenoid fossa fractures and present the beneficial effect of arthroscopy in improving the quality of fracture fixation and overall functional outcomes.
PubMed: 38732322
DOI: 10.3390/diagnostics14090908